调节和集合功能异常引起视疲劳临床分析

Clinical analysis of accommodation dysfunction and convergence dysfunction in asthenopia

目的分析调节和集合功能异常引起的视疲劳患者的临床特征并评价其视觉训练效果。方法临床病例系列研究。收集2012年6月至2013年4月在天津市眼科医院视光中心就诊的视疲劳患者75例，所有患者进行视疲劳主观问卷调查、双眼视功能检查、散瞳验光检查，设计个体化训练方案，在屈光矫正基础上进行每周1～2次诊室训练并辅助家庭训练，共14次。描述性研究视疲劳的临床特征，应用配对t检验比较训练前后的双眼视功能参数并评价训练效果。结果集合不足引起视疲劳者58例（77．3％），集合过度者5例（6．7％），调节不足引起视疲劳者12例（16％）。训练后，所有患者自觉症状减轻。集合不足患者训练前症状问卷得分（22．6±7．4）分，训练后（11．6±4．7）分，差异有统计学意义（t=23．1，P=0．000，P〈0．05）；集合近点（NPC）训练前为（13．1±1．9）cm，训练后为（5．4±1．2）cm，差异有统计学意义（t=33．7，P=0．000，P〈0．05）；近距离正融像范围训练（PFV）前为（17．3±6．5）^△，训练后为（29．7±4．9）。，差异有统计学意义（t=一20．9，P=0．000，P〈0．05）。调节不足患者调节幅度训练前为（8．7±1．1）D，训练后为（14．9±1．4）D，差异有统计学意义（t=22．2，P=0．000，P〈0．05）；单眼调节灵活度从训练前（4．7±3．7）cpm提高到（15．1±2．2）cpm，差异有统计学意义（t=12．96，P=0．000，P〈0．05）；双眼调节灵活度从训练前（3．4±3．4）cpm提高到（14．8±2．2）cpm，差异有统计学意义（t=11．98，P=0．000，P〈0．05）。结论集合不足是引起视疲劳的常见原因，调节不足次之。通过视觉训练可以明显改善患者的集合和调节功能，缓解视疲劳。

Objective To analyze the clinical features of accommodation dysfunction and conver- gence dysfunction in asthenopia and to evaluate the effectiveness of vision therapy. Methods Seven- ty-five patients with visual fatigue were recruited in Optometric Center of Tianjin Eye Hospital from June 2012 to April 2013. All patients had routine eye examinations to exclude eye disease. Based on the results of binocular vision examination and cycloplegic refraction, personalized vision therapy was performed for every patient. On the basis of the refractive, every patient performs office-based vision therapy 1-2 times a week with home reinforcement. It conducted a total of 14 times. All data were rechecked and statistically analyzed by Paired-samples t Test. Results There were 58 cases of convergence insufficiency （77.3%）, 5 cases of convergence excess （6.7%）, 12 cases of accommoda- tive dysfunction （16%）. All patients＇ symptoms were relieved after 14 times vision therapy. The score of questionnaire of convergence insufficiency decreased from （22.6±7.4） to （11.6±4.7）, the dif- ference was significant （t =23.1, P =0.000）. The near point of convergence （NPC） decreased from （13.1±1.9）cm to （5.4±1.2）cm, it showed a significant improvement （t =33.7, P =0.000）. The positivefusional vergence at near increased from （17.3±6.5） ^△ to （29.7±4.9）^△, the change was significant （t =-20.9, P =0.000）. The amplitude of accommodation of accommodative dysfunction increased from （8.7±1.1）D to （14.9±1.4）D, the improvement was significant （t =-22.2, P =0.000）. The monocular ac- commodative facility increased from （4.7±3.7）cpm to （15.1±2.2）cpm, the binocular accommodative fa- cility increased from （3.4±3.4）cpm to （14.8±2.2）cpm, the differences were statistically significant （t =-12.96, P =0.000; t =-11.98, P=0.000）. Conclusions The convergence insufficiency is the most common etiology of the asthenopia, the accommodative dysfunction is the second one. The function of accommodation and vergence improve obviously after reasonable vision therapy. The symptoms of visual fatigue relieve remarkably.